Sciatica is a complex condition that may involve structures in and outside of the spine that increase pressure on the sciatic nerve. The sciatic nerve is the widest and longest nerve in the body, emerging from the lumbosacral spine and terminating in the foot. There is a sciatic nerve located on each side of the body that arises from five separate nerves roots that exit the lumbar and sacral spine. The structures that are involved in causing the symptoms of sciatica include the bottom lumbar nerves (L4 and L5) and the first three sacral nerves (S1-S3). Poor eating habits, body mechanics, and lack of a good diet, may cause the spine to become unstable, which may affect the openings through which the spinal nerves exit the spine. This structural instability may displace certain structures in the spine, affecting the opening through which the nerves leave it. Also, changes to the shape of other structures in the spine, such as the thickness of the vertebral bones, and the rupture of the discs, may cause the constriction of the nerves that form the sciatic nerve.
Other causes of sciatica and sciatic pain may be due to musculoskeletal conditions outside of the vertebral and sacral spine. Due to muscle spasm and certain inflammatory forms of arthritis, the sciatic nerve may be impacted or irritated. Any physical factor that disrupts the functioning of the sciatic nerve may produce pain, changes in sensation (sparks of electricity, burning, tingling), sensation loss, and muscle weakness. These neurologic changes may become permanent if steps are not taken to remove the source of the compression/irritation.
Treating sciatica involves selecting the appropriate therapies that address both the cause and location of the sciatic pain. Treatment options include:
There are many other conservative and alternative therapies that are available to remove the source of the irritation on the sciatic nerve. These are the treatments that we will mention here.
- Physical therapy
- Aquatic Therapy
- Alexander Technique
Anti-inflammatories: Anti-inflammatory medications are designed to provide some level of pain relief, as well as reduce the tissues that have become inflamed to affect the sciatic nerve. The two main type of anti-inflammatories designed to reduce swelling around the sciatic nerve are oral medications and injections. Oral medications used to treat this problem include NSAIDS such as naproxen, ibuprofen, and aspirin. Hopefully, these meds, in combination with rest and icing will provide patients with enough relief to perform the exercise program designed by the physiatrist or other rehabilitation doctor.
If the pain continues for weeks, and does not respond to these treatments, then other medications may be delivered directly to the inflamed tissues, directly by injection. In a large amount of cases, patients experience sciatic pain due to the continued spasm of the Piriformis muscle. This muscle condition is also known as Piriformis syndrome.
The first attempt at treating severe pain from piriformis syndrome through injection will be a Piriformis injection. This injection involves the delivery of an anesthetic agent and steroid directly into the piriformis muscle.
If this treatment does not provide the desired results, then a Botox injection may be done to relax the muscle and break up the tension in the muscle fibers. This injection involves the delivery of the botulinum toxin. Botox is a neurotoxin that contains the bacteria Clostridium botulinum, which has been shown to treat muscle spasms and the effects of other neuromuscular disorders.
Exercise and Physical Therapy: Once you find a combination of treatments that provides you with enough comfort to begin exercising again, you must begin and continue an exercise program that will minimize the chances that you will suffer from the effects of this condition again.
An exercise program may include stretches and strengthening movements that target the right muscles. One stretch that may help is Piriformis Stretche.
Piriformis Stretch: This stretch will involve increasing the flexibility of the piriformis muscle. Get flat on your back, with both legs straight to the floor. Grab your left leg and pull it towards your chest. Put your left hand to the outside of the left knee, and your right hand to the outside of the left ankle. Gently use your hands to pull the raised knee towards the opposite shoulder. This pulling motion should be done slowly and last for about 5-10 seconds initially. Eventually, you will increase the stretch time to 30 seconds. With will repeat this stretch with the right leg. You should repeat this stretch three times a day for both sides of the body.